Fill and Sign the Iowa Evidence Form

1 Prepared By and After Recording Return to: ________________________________ ________________________________ ________________________________ ________________________________ ) ) ) ) ) ) ) ) ) ) ) -------- Above This Li ne Reserved For Official Use Only ---------------- CERTIFICATE OF TRUST (Individual Trustee(s)) STATE OF IOWA COUNTY OF ______________ The undersigned Trustee(s), being first duly sworn, on oath state: 1. The name of the trust is _______________________ __________________________; 2. The date of the trust instrument is _________________________________________; 3. The name of each grantor is: _____________________________________________________________________ _____________________________________________________________________; 4. The name(s) of each original trustee is/are: _____________________________________________________________________ _______________________________________________________________ ______ _____________________________________________________________________; 5. The name and address of each trustee empowered to act under the trust instrument at the time of execution of this certificate: Name _________________________ Address ______ ____________________ ___________________________ ___________________________ 2 Name _________________________ Address __________________________ ___________________________ ___________________________ Name _________________________ Address __________________________ ___________________________ ___________________________ 6. The trustees are authorized by the instrument to sell, convey, pledge, mortgage, lease, or transfer title to a ny interest in real or personal property, except as limited by the following: (if none, so indicate): _____________________________________________________________________ _____________________________________________________________________ ________ _____________________________________________________________; 7. Additional trust provisions: (provisions included by the grantors or trustees; if none, so indicate) _____________________________________________________________________ _____________________________________________________________________ _________________________________________________________________, and 8. The trust instrument has not been revoked, modified, or amended in any manner which would cause the representa tions contained herein to be incorrect. 9. Any person may rely upon this Certificate of Trust as proof of the existence of the Trust, and is relieved of any obligation or duty to verify that any transaction entered into by the Trustee(s) is consistent wit h the terms and conditions of the Trust. 10. This Certificate of Trust is executed as evidence of the existence of the Trust, the terms and conditions of which are incorporated herein by reference. By the terms of the Trust, in the event of the death, res ignation, or incapacity of the Primary Trustee(s), the Successor trustee(s) shall become acting trustee(s) without further act, bond, or order. 3 The statements contained in the Trust Certificate are true and correct and there are no other provisions in the trust instrument, or amendments to it, that limit the powers of the trustees to sell, convey, pledge, mortgage, lease, or transfer title to interests in real or personal property. I/We, the currently acting Trustee(s) of the above described Trust, declare under penalty of perjury that I/We have read the foregoing Trust Certificate and that it is true and correct to the best of my information and belief. Date: ___________________ Signature of Trustee _____________________________ Print Name _______ _____________________________ STATE OF IOWA COUNTY OF ______________________ On this ____________ d ay of ______________________, 20____, before me, a Notary Public, personally appeared __________________________________, to me known to be the person named in and who executed the foregoing instrument, and acknowledged that he/she/they executed the same a s his/her/their voluntary act and deed. ______________________________ Notary Public Print Name: ___________________ (Seal, if any) My commission expires: _____________________ Signature of Trustee _____________________________ Print Name ____________________________________ 4 STATE OF IOWA COUNTY OF ______________________ On this ____________ day of ______________________, 20______, before me, a Notary Public, personally appeared __________________________________, to me know n to be the person named in and who executed the foregoing instrument, and acknowledged that he/she/they executed the same as his/her/their voluntary act and deed. ______________________________ Notary Public Print Name: ___________________ (Seal, if any) My commission expires: _____________________ Signature of Trustee _____________________________ Print Name ____________________________________ STATE OF IOWA COUNTY OF ______________________ On this ____________ day of ______________________, 20______, before me, a Notary Public, personally appeared __________________________________, to me known to be the person named in and who executed the foregoing instrument, and acknowledged that he/she/ they executed the same as his/her/their voluntary act and deed. ______________________________ Notary Public Print Name: ___________________ (Seal, if any) My commission expires: _____________________